Three distinct breakfast patterns and the presence of atherosclerotic plaques in asymptomatic individuals were observed.

Twenty percent of study participants regularly ate a high-energy breakfast, providing more than 20 percent of the recommended calorie intake.

The largest proportion, 70 percent, ate a low-energy breakfast (between 5 percent and 20 percent of daily calorie intake) and 3 percent either skipped breakfast or ate less than 5 percent of their daily calorie intake. Individuals in this last category spent less than five minutes on breakfast, consuming only coffee or fruit juice, if they ate anything.

Researchers said the results suggest that skipping breakfast is also an indicator of more generally unhealthy lifestyle habits, associated with a higher prevalence of generalized atherosclerosis.

The CNIC research team also found that this group tended to have more generally unhealthy eating habits and a higher prevalence of cardiovascular risk factors.

Eat like a horse in the morning

The findings didn’t surprise Dr. Ragavendra Baliga, a cardiologist who is a professor of internal medicine at The Ohio State University Wexner Medical Center.

“The findings of this study [the PESA study] and the more recent findings of the PURE study in the Lancet [in August] encourages me to continue what I have recommended for years to my patients. That is, ‘Eat like a horse for breakfast, a puppy for lunch, and a bird for dinner,’” he told Healthline.

“The trends of skipping breakfast by an estimated 20 percent to 30 percent of adults mirrors the increase in obesity and the accompanying cardio-metabolic derangements including hardening of arteries noted in this study,” Baliga explained.

Baliga follows his own advice.

“In addition to having a heavy breakfast, I encourage that my patients avoid carbs at night since carbs is a ‘fuel food’ and at night we sleep so we need less carbs. I encourage them to have more protein and vegetables at night.”

One result: “I myself have lost 10 pounds in the last 18 months by reducing carb intake in the evening,” Baliga said.

What’s best to eat?

The question then arises: What to eat?

Mara Weber, MS, RD, LD, a clinical dietitian at The Ohio State University’s Richard M. Ross Heart Hospital, is full of ideas on that topic.

“Because fasting puts stress on the body, breaking your nightly fast when you wake is key,” Weber told Healthline. “Fueling your body with the right kinds of food is essential to help set yourself up for a successful day.”

“A cup of coffee and a donut might provide you with adequate calories, but they won’t provide you with the right fuel you need to sustain you until lunchtime,” she said.

Her suggestions fit right in with the results of the Spanish study.

“Aim to eat about 25 percent of your daily calorie intake at breakfast so you’re not starving by noon,” Weber said. “The important thing to keep in mind is that foods should be a good blend of high protein, fiber, and some carbohydrates.”

In a hurry?

“Planning ahead of time is key,” Weber said. “If you don’t have it on hand, you’re likely to grab something that just doesn’t cut it or skip it entirely. Make anything you can ahead of time and pack it like you would your lunch.”